HomeMy WebLinkAboutX2015-3405 - Permits (3)City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660 X 2 0 1 5
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255Issued
US"..'..Combination Type - BLDG
3 4 0 5
COMB Permit: X2015-3405
Project No
Date
Inspection Ar _
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST
VALID INSPECTION.
NA,
Job Address: 35 SHEARWATER PLB N�
Description: DEMO SPA 11'8" X Ti METHOD "A" (CITY STANDARD PLAN)
Legal Desc.: N TR 12529 LOT 36 -
Owner: ROKOS GREGORY Contractor: OWNER/BLDR
Architect:
Address: 35 SHEARWATER PL Address: ROKOS GREGORY
Address:
• -
NEWPORT BEACH CA 92660
Phone: 714-801-0251 Phone: 714-801-0251
Phone:
State Lic: .
Applicant: ROKOS GREGORY Con State Lic: O/B
Engineer:
... ,
Address: 35 SHEARWATER PL Lic Expire:
Address:
NEWPORT BEACH CA 92660 Bus Lic:
Phone: 714-801-0251 Lic Exp Date:
Phone:
State Lic:
Code Edit : 2013 Worker's Compensation Insurance
Designer:
Type of Construction: Carrier:
Address:
Occupancy Group: U Policy No:
-
Added /New sq.ft. Bldg: 0 Expire:
Phone:
,
Added /New sq. ft. Garage: 0
..
No of Stories: 0 Building Setbacks Rear: /
Special Conditions:
No of Units : 0 Front: /
Bldg Height: 0 Left: /
Bldg Sprinklers: Right: /
Fined Zone: X Use Zone: Parking Spaces: 0
Fire Hazard Zone : N
Building Permit Fee:
$99.00
Excise Tax:
$0.00
Planning Department -
Fire Department
$0.00
Plan Check Fee:
$71.28
Additional Fee :
$0.00
Plan check Fee :
$0.00
Fire Inspection:
$0.00
Overtime Plan Ck:
$0.00
Fair Share :
$0.00
Fire Plan Rev
Investigation Fee:
$0.00
Grading PC Consultant :
$0.00
SJH Trans :
$0.00
Demolition Fee
$0.00
Record Management:
$2.00
Grading Permit Fee:
$34.80
In -lieu Housing Fee :
$0.00
Building Dept Adm
$0.00
Energy Compliance:
$0.00
Grading PC Fee:
$0.00
Public Works Department -
General Service
$0.00
CA Seismic Safety:
$0.00
WQ Insp. Fee:
$23.20
Park Dedication :
$0.00
Refund Deposit
Disabled Access :
$0.00
PAN Plan Check :
$0.00
Hazardous Mat
$0.00
Electrical %:
$0.00
San Dist :
$0.00
$0.00
Building Green Fee :
$1.00
Mechanical %:
$0.00
NMUSD Fee:
$0.00
Plumbing %:
$0.00
$0.00
TOTAL FEE : $231.28
Plan Check Fee:
$0.00
Fee Due at Permit Issuance :
$231.28
PROCESSED BY:
ZONING APPROVAL:
GRADING APPROVAL:
PUBLIC WORKS APPROVAL:
PLAN CHECK BY:
APPROVAL TO ISSUE:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s)
Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
ie permit to file a sinned st^tement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
'rofessions Code) or that he or she is exempt from Iicensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
of more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
n r vements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
np r the purpose of sale).
Ps owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
y to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
� I am exemp, from Iicensure under the Contractors State License Law for the following reason:
y .iy Signature below I acknowledge that, except for my p esidence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot Iegall;
all a stricture tha' I have built as an owner -builder if it has n een strutted in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of th Busin ss and
ToTs�ions Code, is available upon request when Ic is s fitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
lignature of Prope,ty Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATI
hereby affirm unde. Ht.nalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
nd effe:t. License Cliss License No Date Contractor Signature
CCMPENSATION DECLARATION
ING. FAILURE TC SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm undo penalty of perjury one of the following declarations:
I have and will mantain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for
ormance of the work for which this permit is issued. Policy No.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensa
rance carrier and policy number are:
Policy Number
of Agent
Date
certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and
, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant Date_
CLARATION REGARDING CONSTRUCTION LENDING AGENCY
)reby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097
iders Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the pro is behalf.
I have read this application and the information I have prov ect.
I agree to comply with all applicable city and county or ante nd to laws relating to building construction.
I authorize representatives of this city or county t me a-i 'tified property for inspection purposes.
nature of Property Owner or Authorized Agent
Ar77W1 DAIF BY
PFRbfIT FXPIRFJ
2EiRIJ7CANCELLED
PER1,17 EY TEIJOED
PENIXT rnuAL I 1 / 25 It
CERTIFICATE OF
OCCUPANCY�55CFO
'sys
Print Property Owner's or Authorized Agent's
FEDERAL RECULd TfONS PART 61 OF TITLE& AND
A0I1140RULC 1403.
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NOT.MPJCABLE TO
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